Provider Demographics
NPI:1518194083
Name:MASSAROTTI, HAANE GRACE PEREZ (MD)
Entity Type:Individual
Prefix:
First Name:HAANE
Middle Name:GRACE PEREZ
Last Name:MASSAROTTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4680
Mailing Address - Country:US
Mailing Address - Phone:813-615-7366
Mailing Address - Fax:813-615-8350
Practice Address - Street 1:3000 MEDICAL PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-615-7366
Practice Address - Fax:813-615-8350
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN18200208600000X
PAMT197944208600000X
FLME121158208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery